Opposition Mounts on Proposed ACO Regulation

The proposed rule for the Medicare Shared Savings Program/accountable care organizations (ACO) has suffered some recent blows. Ten major multi-specialty organizations wrote to HHS Secretary Sebelius and CMS Administrator Don Berwick voicing their collective concerns with the proposed rule and stating that if major changes were not made, they would not participate — and would oppose implementation. This is a setback for the administration since all 10 groups, including Geisenger Clinic and the Marshfield Clinic, have participated in the Physician Group Practice Demonstration, which was one of the shared savings models.

Additionally, seven Republican Senators wrote to Sec. Sebelius urging the administration to withdraw its proposal since so many large integrated health systems, such as the Mayo Clinic, have expressed strong reservations on the current proposal and believe it is currently unworkable.

AGA is finalizing our comments on the proposed ACO rule, which are due on June 6, with a team of members who have been instrumental in helping to deconstruct the proposal and its impact on gastroenterologists and patients with chronic GI conditions. We share many of the sentiments expressed by the large multi-specialty organizations.

The AGA does not believe that this currently proposed model is “ready for prime time” and will urge CMS to delay its implementation. We are extremely concerned about how this proposal will impact patients’ ability to continue to access quality specialty care services, especially those patients who have chronic GI conditions such as IBD, chronic liver failure or hepatitis C. We agree with the large organizations on their structural concerns with establishing an ACO and the financial resources it will require, which are underestimated by CMS. However, our major concern is for those patients with complex, chronic conditions who often see multiple providers in various settings and rely on a team of specialists to coordinate their care. The current model, as proposed, focuses on primary care, and therefore could limit appropriate referrals to specialists. We will post our comments on the AGA website when they are finalized.

AGA will continue to update our members on the progression of the ACO rule as the comment period comes to a close and what types of changes CMS makes to the proposal. Look for more updates on the AGA Washington Insider and in AGA eDigest.